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UTILITY PEF�MIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everetlwa.org <br />.2 � UGt V i /_G, �'� �� �-c�-L <br />PROJECT ADDRES <br />S k� <br />Property <br />N'� ti�� crT �30�, �� �y, h�: <br />Mail AGtlress <br />ienant Name (If ihis is lor a commercial business) <br />Ciiy <br />L'{/� � <br />ri�,c/� 3 1 S 5� Y"7 <br />StatelZip Phone <br />!�ufi� lw-�yi IiSI S'-1 r LS,H S(�v S„��wi—:Z� �-✓�- �1,YZSV `�!'LS %10 B'?Go <br />ConlreClO� �h�tad�ddress City Stale2ip Phone <br />M u-c✓� Pn.� �3 �U <br />WA Stale CoNractor License Number (requucd) <br />Work lo bc done: <br />❑ Side Sewer Repair <br />❑ Side Sewer Alteration <br />❑ Side Sewer - New Installation <br />� Install [3ackwater Valve (outside the building) <br />❑ Cap of( 5ewer <br />❑ Install Water Meter <br />°��i�-- 3 -�- S-� S <br />- - !� - - - <br />Signalurc Dale <br />RFVISf U 11/19^01d <br />��� S <br />Cdy of Evere�l �usmess Litensc Number (tequired) <br />Ire[ — -- <br />��'�.�i <br />� <br />�UE. �,�50 3- i3� <br />� <br />